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Brad and Josie - Initial Cancer Treatment Part 2

• Brad Buchanan and G [Josie] van Londen • Season 1 • Episode 5

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In this second part of the podcast episode, hosts Brad and his co-host delve into Brad's harrowing experience with aggressive cancer treatment. Initially diagnosed with an indolent form of cancer, Brad's condition rapidly worsened, leading to an emergency hospitalization due to a burst tumor in his lung. The episode details the intense therapeutic measures taken, including aggressive chemotherapy, the physiological and psychological toll, and the extensive hospital stay.

Brad shares his firsthand experiences of treatment, recovery challenges, and complications, ultimately highlighting the resilience required to endure such a grueling medical journey. The episode also touches on the importance of personalized care, the potential impact of prehabilitation, and the evolving nature of oncology treatment methodologies.

Helpful Links:
https://www.elsevier.com/products/clinicalpath

https://www.cancer.org/cancer/managing-cancer/side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer/preserving-fertility-in-women.html

https://www.cancer.org/cancer/managing-cancer/side-effects/fertility-and-sexual-side-effects/fertility-and-men-with-cancer/preserving-fertility-in-men.html

https://www.dana-farber.org/health-library/how-prehabilitation-can-benefit-cancer-patients



G [Josie] van Londen:

Hello everybody, welcome to the second part of our podcast episode about Brad's and my discussion about our initial cancer treatment phase. The previous episode we talked a lot about my cancer treatment and some philosophical conversations, and now we will start right off by talking with Brad about his story. So let's go, Brad, your turn.

Brad Buchanan:

Yeah, no problem. Okay, I will launch into my story because I was treated. Once I was finally a diagnosed and then admitted to the hospital with the hemoptysis coughing up lots of blood from the burst cancerous tumor in my left lung, I was treated extremely aggressively with a bolus of chemo drugs. It took, I don't know, maybe two or four days for them to finally figure out what was going on. But they realized that the cancer they thought was indolent and more or less confined to my skin or just underneath it, had been sneaky and gotten into one of my organs and had poked a hole in my left lung. So they hit me with a bolus of chemo drugs. I think they called it CHOP.

G [Josie] van Londen:

And.

Brad Buchanan:

I forget what all is in there.

G [Josie] van Londen:

You may have a better idea than I do at this point, but I think there was cycloph and oncovin or something like that, and maybe a couple of other things too yes, chop capital c, capital capital O, and capital P stands for agents cyclophosphamide or cytoxan, doxorubicin or adriamycin, vincristin, which used to be called oncovin, and a steroid to P is prednisolone.

Brad Buchanan:

Okay, yeah, and then so that really knocked me for a loop. What happened was that my left lung basically completely collapsed, partly due to the hole in it because of the cancerous tumor, but in a way, the cancer had been the only thing keeping my lung together at that point, it would seem so. When the cancer receded, I was coughing up all of those dead cells that had been in my lung that were killed, I suppose, by the chemo and drugs. I was having great difficulty breathing, I was coughing a lot and had to be on an oxygen tube, and ended up staying in the hospital for 19 days after I was admitted in the cancer ward.

Brad Buchanan:

It was quite yeah, it was a very aggressive form of treatment, because they realized, in a way, maybe they overreacted in some sense and didn't take into account what the blast of chemo that they were giving me would actually do. But I don't know, maybe that was exactly what was needed at that time. Since I survived, I've just kind of accepted the aggressiveness of that initial treatment as okay, that's how it had to be right. Once they realized that the cancer was much more insidious, and indeed life-threatening, than they had first thought it to be, they felt like the best thing to do was finally to treat this thing before it invades any other vital organs. Let's say, but yeah, in the process I was super sick and in the hospital for quite some time.

G [Josie] van Londen:

I wondered Brad, two things. One is, for somebody who has never really been sick, being in the hospital for three weeks the first time around with major health issues was probably super duper scary. And the second comment is I wonder if another reason why I wanted you to be treated the first time as an inpatient is because of the tumor lysis occurrence, which is the heavy duty chemotherapy needed to treat the tumor, is killing the cancer cells so quickly that those cancer cells die and release all that toxin in your system which we need to support you with, to help you, as you said in your poem, piss out your chemotherapy but also your debris from the cancer cells if that make sense, and the electrolyte abnormalities and organ damage that could occur from that.

G [Josie] van Londen:

they had to support you through that. They've been monitoring your blood volumes and your ins and outs, fluid-wise, etc.

Brad Buchanan:

That was my impression at the time. It was like, oh yeah, I absolutely need to stay in the hospital after they hit me with that bolus of chemo Although I will say that the hospitalist at the time was European and he said I'm in Europe, you might just have been sent home after that and recover there, just fine. I was like, ok, maybe, but here we are in North America, so that information doesn't help me at all. But now I wonder maybe he was onto something. But yeah, I I do think I was in pretty rough shape, I gotta say. And yeah, it was overwhelming to feel like, yeah, everything in my body had suddenly just changed in a way that I couldn't really understand and had a hard time accepting. I was in a lot of pain. I was coughing up a lot of gray junk from my lung that was those dead cells that you're talking about about as well as peeing bright red urine into the tankard very copiously and simultaneously horrendously constipated from all the painkillers I was on. It was quite something, it was a real. I was plunged into cancer treatment at the deep end, I'll just put it that way. And yeah, I didn't know if I would survive even that initial blast. By and large. Yeah, I came out of it okay.

Brad Buchanan:

There was some question of what to do with my left lung, that there was a possibility that they might want to drain the fluid, sort of surgically, like put in a drainage tube into my body somewhere. But the people from internal medicine came and had a look at me and they said, no, you're not in good enough shape for us to do that. You know, my immune system had kind of taken a hit. I suppose they thought that an opportunistic infection might really give me a lot of damage, that an opportunistic infection might really do me a lot of damage. The pulmonologist at the time said that the best thing to do is just to try to let the left lung reinflate itself slowly. I did a lot of breathing exercises, breathing into a device that measured how much air I could emit, the force in which I was able to breathe out.

G [Josie] van Londen:

Was that an incentive aerometer?

Brad Buchanan:

Maybe. So there were a lot of devices deployed to figure that out and actually later on that became really important. Going in for the stem cell transplant was whether my lung had properly re-inflated and had resumed its functions, and thankfully it had. I have no, from what I can tell, I have no residual lung damage from that whole event. So I think my pulmonologist was very wise to say yeah, we're not going to. There's no magic bullet here. To use another favorite American saying in medical terms, there's no silver bullet or what have you. It's just like your lung will want to heal itself, whether you believe it or not. You need to help it in certain ways by trying your best to like walk around, get some exercise, learn how to breathe again, and I was functioning with one lung for a while and I did need oxygen, even when they sent me home after those 19 days. But yeah, he was right, and so my left lung was just fine as far as anyone could tell.

Brad Buchanan:

And it was funny because my medical teams were sort of blaming each other for that lung disaster before they knew what was going on. My oncologist thought that my pulmonologist had actually punctured a hole in my lung when they did the bronchoscopy Just before my tumor burst. They wanted to find out what was causing the opacity in my left lung and why I was coughing so much. So they sent a bronchoscope down into my lung to have a look at things and they didn't find anything, because your lungs are apparently just a labyrinth where it's actually very hard to locate like a single tumor, even though it's pretty big. And they weren't even looking for a tumor anyway. They just had no idea what it was about. So they were blaming each other, the oncologists were blaming the pulmonologists, and the pulmonologist said he has cancer, maybe you should have treated that, and I guess the pulmonologists were right.

Brad Buchanan:

So anyway, that was the first dose of chemotherapy that I got in the hospital with a burst lung tumor and they let me recover from that at home for a while. It took a while for me to get into shape again to go back in because they knew my cancer was still there. But I'll pause. You look like you have a question coming.

G [Josie] van Londen:

Yeah, how do you know? There's a few things going through my head. One is you were exercising quite a bit, and I think that may have done a great benefit to your body, because you went into this, relatively speaking, as fit as you can.

Brad Buchanan:

Yeah.

G [Josie] van Londen:

I think that may have helped you to tolerate the setback you had.

Brad Buchanan:

Yeah, it certainly made good that I stopped smoking 10 years or so before all of this happened. Yeah, I smoked as a teenager. I always thought, oh, maybe my cancer because I used to smoke. But nobody made that connection and I wasn't one cancer anyways. But yeah, I was kind of in the best shape of my life as cancer was forming in my body. It was almost as if I was in training to survive cancer. I didn't know it at the time, but it's almost as if that was happening.

G [Josie] van Londen:

Isn't that weird how things work out that way. Sometimes in hindsight, you wonder if, at some deeper level, you sort of knew that this is what you had to do yeah, I think it's.

Brad Buchanan:

I think it's definitely an open question. I mean, what had happened in my personal and professional life at that point was I had kind of because I was in a very stressful job. I I was chair of the English department at Sacramento State University for three years and I kind of let my health slide. I was eating too much, I was drinking too much coffee, I was drinking too much alcohol as well, and so I really, yeah, I kind of let myself become less healthy.

Brad Buchanan:

I was exercising during that period, but not as much as I was when I finally got relieved of my duties as chair or where I declined to stand for reelection I'll put it that way Because the job had been really awful, stressful and frustrating and all kinds of difficult. So after that I was like, okay, I need to get myself in better shape, because I really, because of the job pressures, I ignored my physical well-being for three years essentially. So I threw myself into that as a reaction to the three-year period of having to go to all these committee meetings with HR and all the other nonsense that goes with campus leadership position. But yeah, maybe on some deeper level I thought my body thought run for your life run Forrest, run Forrest, go movie, something along those lines. But in my mind I did have a good reason for getting it, cancer notwithstanding.

G [Josie] van Londen:

But that's also a change. In the field of oncology they call it pre-em. Most of us are familiar with the fact that rehabilitation after treatment can help and they're moving up more and more to during treatment for those who are, like weeks, admitted for a stem cell transplant as well as before the treatment starts, to optimize your body, your system, to be able to withstand and tolerate yeah and hopefully build up some reserve before the treatment starts, which is a very interesting.

G [Josie] van Londen:

We used to say, when you're undergoing treatment, to stay in bed. Those stem cell transplant patients just rest. Also, how was it for you to see the chemo bags coming into the room and just see them being? Some people have a very visual of how it's flowing through your bloodstream very visual of how it's flowing through your bloodstream, and so I don't know if you remember that moment. For many people, that's a moment that they'll never forget.

Brad Buchanan:

And other people. It's like I've repressed it or I don't remember. I don't really remember it. In that first 19-day stay particularly, I was hooked up to an IV anyway, because they needed to pump fluids into me, so I was hooked up to something. What they eventually did, though, is they had to place a catheter, a PICC line, in my arm, so that was my first kind of initiation really into into chemotherapy. They placed a PICC line in my arm, and it was one of my least favorite experiences I've ever had. I was there fully conscious while the nurse installed this thing, and, yeah, my wife was there and she read the comic british fiction to me while I suffered through this little mini ordeal wait, brad, because some might not know what a pick line is.

G [Josie] van Londen:

a pick line p, I, c, c is a peripherally inserted central catheter that some people need to use if the fluids that get infused through it are too toxic for the small peripheral veins and or the small peripheral veins are not easily accessible anymore due to previous chemotherapy or diseases that affect the ability to catalyze. A big line is a sort of central line that continues to have a piece hanging outside of your body. It's not hidden. You can shower with it, you can swim with it.

Brad Buchanan:

Yeah, I was hooked up to an IV with liquids in it for quite some time and so when the chemo drugs finally came I was just good, let's go Like, are you finally going to treat this cancer buddy, like I was. By that point I was a little frustrated with my initial oncologist who had incorrectly assumed that the cancer was very slow moving and not especially threatening. So, yeah, I didn't have really strong feelings about the chemo itself when it started. I will say that, yeah, later on I actually kind of enjoyed the later chemotherapy sessions.

Brad Buchanan:

The first one was so bad and I had so many unpleasant side effects of being hammered with this huge bolus of chemo that going back in for the second one was psychologically challenging.

Brad Buchanan:

But it was a breeze actually Compared to the first one. The second one was like I don't know, getting a nice infusion of new blood or something. It was completely benign and these treatments were basically I was in the hospital for four nights consecutively and they would infuse me with various things for various lengths of time and then I'd go home and I was neutropenic for part of that time at home so I could socialize, didn't go into restaurants and so forth, but but yeah, it soon became kind of a routine where I would bring my computer into the hospital. I had a writing academic project that I was hammering away on, so I'd bring books, I'd bring music, I'd have stuff to entertain me, and it became a little bit of a yeah, almost like a nice little spa vacation in the cancer ward by the end of that summer of chemo met in the cancer ward by the end of that summer of chemo, Some patients would actually literally come in their suitcases all kinds of stuff keep themselves comfortable and entertained.

G [Josie] van Londen:

Interesting to see once they learn what they really need in the room. The story also aligns with the tumor lysis that you read. When the tumor lysis theory, when the tumor bulk is the biggest in the beginning, the tumor lysis phenomenon and the related side effects are also the worst, and so the fact that your next treatments were better tolerated goes along with the theory that your tumor bulk is decreasing. Goes along with the theory, and it can. Tumor bulk is decreasing, so you're mostly dealing with this and the side effects of chemo itself.

Brad Buchanan:

Yeah, which by my sixth cycle, sixth and final cycle in that summer, I didn't notice many side effects at all.

Brad Buchanan:

I will say that as my left lung reinflated, I did start to become more active again and I even played soccer two more times before I realized that running was going to be challenging because my joints started to really hurt and to this day I still can't really run the way I used to. I bike, I walk, but sort of the impact on my knees in particular of running is too, is too painful these days, and I gather that chemotherapy has something to do with that, that it somehow robbed my joints of some of their strength. I don't know exactly how to put it, but that's just my experience of things. So I had to shift the way I exercised. So I had to shift the way I exercised. So, yeah, I now ride my bike or do stationary bike riding, take short walks fairly frequently and lift very light weights. But yeah, I still feel really invested in my modest exercise routine that I kind of hit upon as I transitioned out of that summer of chemo into the transplant mentality. But we'll deal with that in a later episode.

G [Josie] van Londen:

Yes, we will. I like your observation, and maybe one possible explanation for the fact that you have more pain with running and so you had to change your exercise regimen is that cancer treatments, in particular chemotherapy, can accelerate your aging process and potentially maybe it can accelerate your osteoarthritic disease process. Running really puts a strain on your knees and your ankles, your joints and people with osteoarthritis really have a hard time running. And so it's interesting that you changed your physical activity level to offload your joints.

G [Josie] van Londen:

So that's an interesting observation. I think you're very observant of your bodily changes.

Brad Buchanan:

I mean, it was pretty clear I love playing soccer and I played it for my whole life. Basically, I played one great final game where I felt great, and then the next week I came back and I was like, oh yeah, I played one great final game where I felt great, and then next week I came back and I was like, oh no, I can't do this at all. And that was that Because I would have kept going, for sure if I'd been able to, but it was just too painful.

G [Josie] van Londen:

But you're very creative. I think you go on.

Brad Buchanan:

Yeah, I feel better with a modest but regular exercise regimen. Yeah, I have adapted. I've had to adapt.

G [Josie] van Londen:

And maybe this is a plug for me to add for individuals who've never exercised before but would like to exercise, or those who have exercised before but are now, after cancer treatment, concerned about how to resume exercise in a safe way. Please discuss that with your healthcare providers. There are different ways to be supported through this the physical therapist, the personal trainer, exercise physiologists, summer cover, insurance. Don't hesitate to ask for help. Brad, did you tell us how many cycles of that inpatient chemotherapy you got for urinary treatments?

Brad Buchanan:

Six.

G [Josie] van Londen:

Six Okay.

Brad Buchanan:

Yeah, so that was every three weeks. Yeah, I think it was after the initial treatment and the kind of semi-catastrophic side effects. We waited longer than that, but, yeah, once I went back in for my second one and it was tolerable, then, yeah, I was in every three weeks for that four-day stay in the hospital and they were prepping me for at that point was supposed to be an autologous stem cell transplant where I'd be my own donor. But and maybe this is a way of looping back to our earlier discussions the aggressive chemotherapy they gave me seemed to make my slow-moving cancer come back really fast which it did and so I was suddenly no longer a candidate for the autologous stem cell transplant and I needed a donor in a big hurry. So, yeah, they did not knock my cancer into any type of lasting remission.

G [Josie] van Londen:

But then, by the way, this whole ordeal and six cycles every three weeks or so it's almost six months ongoing. That put a big number in your life, your family life, your personal life your work, life I mean everything Be a doctor, thank you.

Brad Buchanan:

I mean, my job was such that, as it happened, I was on sabbatical when I was diagnosed. Wow, after 12 years of teaching, I finally got the sabbatical.

G [Josie] van Londen:

You got your treatment during your sabbatical.

Brad Buchanan:

Yep.

G [Josie] van Londen:

Oh my, isn't it creepy how that all worked out. Yeah, but you wonder if there's some higher power who was trying to protect you, or a subconscious effort on your behalf. Wow.

Brad Buchanan:

Yeah, if I'd gotten my sabbatical in my seventh year, as you're supposed to. That's what sabbatical means, right? The thing you get every seven years.

G [Josie] van Londen:

Yeah.

Brad Buchanan:

I wouldn't have been in that situation. But at a California State School you're lucky to get any kind of sabbatical at all. But yeah, I was writing a research project that eventually was published like nine years later. But yeah, so since I wasn't teaching that semester, I made cancer my full-time job. Even before I was treated I was writing a way to say are there any clinical trials out there for my first cancer? There didn't seem to be any. But yeah, I was fortunate. I mean I never caught again. I had to retire early because of all my medical problems. But yeah, I'm glad I was on sabbatical that semester because it was certainly an all-consuming struggle. Once my tumor burst, we had just entered into a whole new world.

G [Josie] van Londen:

Yes, in terms of your burst tumor, given your diagnosis with an indolent lymphoma of your skin. I just had a random thought that ties into our discussion of earlier this episode or maybe it was the prior episode about clonal selection. Maybe somehow your tumor started mutating very early and spontaneously, before you started cancer treatment, and develop some aggressive clones that spread to your lung.

Brad Buchanan:

Yeah, that's the big question, that no one really knows what turned my allegedly slow-moving endocrine cancer into a malignant, fast-moving cancer. No one ever really explained it to me and the doctors weren't going to say, oh yeah, all those chemo treatments we gave you, they've kind of just roused the cancer into an even more menacing state. They wouldn't quite cop to that and I don't know that's necessarily what happened anyway. But yeah, I will underline again in this episode how unusual and rare my form of T-cell non-Hodgkin's lymphoma was. It didn't manifest in any of the normal ways that they were expecting and in a way that's why I felt it was important to switch oncologists.

Brad Buchanan:

After my first bolus of chemo, my wife met a woman at the gym whose husband also had an extremely rare form of lymphoma and they got to talking and so my wife heard about this different oncologist at the same hospital, by the way, but we switched to him and he's been my oncologist ever since.

Brad Buchanan:

So in a way, yeah, my cancer was unusual and certainly didn't present normally to start with, but at least I got in to see the best person at that institution who could give me, ultimately, I think, what was the best advice for how to go forward with the treatments and I got second opinions about this at various times, but none of the second opinions made me reevaluate the care available at my home institution. So I was lucky to be living very close to an excellent hospital, at the first rate cancer center and a stem cell transplant program, so I had pretty good wraparound care in that regard. But yeah, my, my cancer was very weird. Eventually I met the husband of the woman my wife had met and we sort of chatted about our rare cancers and discussed whether we should wear T-shirts saying my cancer is more rare than your cancer or something like that.

G [Josie] van Londen:

Yes and both. Beyond that, I think every tumor has the potential to behave in a very unique way that might fall into patterns but still is unique for one person. So I think it always needs that human, personalized touch in terms of treatment decision-making. Artificial intelligence may be able to enhance treatment decision-making, but I don't believe it can ever fully replace it, but that's a story for another day. Another thing to comment on is that you went to get multiple second opinions. That's a topic on its own. Perhaps also let us know in the comments if you would like us to elaborate.

G [Josie] van Londen:

Not everybody has the courage, opportunity, energy and time to do so. Some cancer treatments need urgent treatment, not allowing fertility preservation either. It can be a whole ordeal to pursue a second opinion to find somebody who has your expertise, somebody who has your expertise, and to deal with the political implications If you're seeing somebody in the same practice or a competitor of your current oncologist. Please note, you're never obligated to explain why you're pursuing a second opinion. Another dynamic that comes into play is that you need to find somebody with whom you click, somebody you trust, because it's really sort of a relationship that you need to grow and foster, and if a trust is not there. It really impacts everything, including your peace of mind and comfort about the treatment decisions you make.

G [Josie] van Londen:

Lastly, I wanted to add something about expectations. It is becoming more and more common that treatment has been turned into an algorithm, meaning it's not so much that you will get a total different treatment approach if you seek out opinion, because cancer treatments are evolving so quickly. There are algorithms set up at national level that are constantly reviewed by a large panel of experts to see if it needs to be updated to allow all of us to give the latest and greatest treatment to our patients, even if we don't necessarily have the time to keep up with the literature. In particular, this is the case for community docs who treat multiple different tumor types and may not have the time to delve into updating themselves constantly on each specific tumor type. These algorithms have been set up to prioritize survival prioritize survival and, where survival is the same, agents will be prioritized that favor tolerability and affordability.

G [Josie] van Londen:

Furthermore, in terms of expectations, it's important to look at the relationship how you click with the other doctor, as well as research studies. Every cancer center may have access to different types of research studies, which you can find online in a website that I will put in the comments clinicaltrialsgov. That will allow you to see if there's any studies particular to your situation that may necessitate you to travel elsewhere. Wow, brett, I think for today, maybe this episode is enough. I think we have a lot of thoughts. I will put some links in the description to expand on some of the things we talked about here, and then the next episode we can continue to elaborate on what we talked about today, maybe start talking about the recurrences that both you and I experienced.

G [Josie] van Londen:

What do you think?

Brad Buchanan:

Brad Sounds good.

G [Josie] van Londen:

I'm very grateful for our discussion today, Brad, and I'm sending you a big yeah, no, these conversations have been fantastic.

Brad Buchanan:

Your training and medical knowledge is extremely interesting to me, as well as your personal story. There's a lot to think about and a lot to talk about. I'm me as well as your personal story. So there's a lot to think about and a lot to talk about. I'm enjoying it as well.

People on this episode

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Josie

Host
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Brad Buchanan

Co-host